Proceedings

Failure of the Percutaneous Intra-Aortic Balloon to Unwrap–A Case Report

Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710

^* Reprint address: Steven E. Curtis, Box 3043, Duke University Medical Center, Durham, North Carolina 27710.

Abstract

An intra-aortic balloon which can be inserted percutaneously has become an attractive adjunct in the past few years. The major benefits of this technique are ease and speed of insertion and the lack of need for a surgical cutdown. Early concerns about post balloon removal hemorrhage due to the large catheter size (12 French) have largely proven to be unfounded. Early experience suggests that the most frequent problem associated with percutaneous insertion has been failure of the balloon to completely unwrap. This problem was observed in 17 of 96 patients (17 .8%) in whom the balloon was inserted perioperatively. Usually, the problem is recognized immediately. The balloon is then withdrawn, re-wrapped, and reinserted or replaced with another balloon. In two patients, failure to completely unwrap was not recognized until later. One patient had the balloon removed while another was simultaneously inserted into the contralateral femoral artery without complication followed by improved and normal balloon function. The second patient is presented depicting recognition of the problem and subsequent solution.